Assessment of tumor volume and density as a measure of the response of advanced hepatocellular carcinoma to sorafenib: Application of automated measurements on computed tomography scans

Abstract

Background and Aim To better predict patient survival, we used automated tumor volume and density measurements to make an objective radiological assessment of the response of advanced hepatocellular carcinoma (HCC) to treatment with sorafenib. Methods Patients treated with sorafenib were identified retrospectively. Those who were diagnosed with Child‐Pugh class A liver function, Barcelona‐Clinic Liver Cancer stage C, and Eastern Cooperative Oncology Group performance status grade 0/1 were enrolled (n = 22). Reviews of contrast‐enhanced computed tomography images were supported by the automated measurement of lesions using computer software. Treatment responses were assessed using volume and density criteria. Kaplan–Meier methods and multivariate Cox regression analysis were used to evaluate treatment responses and identify the most significant prognostic factors for overall survival (OS). Results After patients were dichotomized according to volume and density criteria, the median OS for those with an objective response (OR) (complete response + partial response) was 20.4 months and that for those with a non‐OR (stable disease + progressive disease) was 9.3 months (P = 0.009). The best multivariate regression model for survival identified volume and density criteria (OR or non‐OR) as a significant variable, along with baseline alpha‐fetoprotein levels (log‐rank test, P = 0.01). No other conventional criteria were identified as significant. Conclusions Tumor volume and density assessment using automated lesion measurements may be an objective method of evaluating responses of advanced HCC to treatment with sorafenib.

Focal liver lesions: interobserver and intraobserver agreement of three-dimensional contrast-enhanced ultrasound-assisted volume measurements

“…The availability of dedicated software for 3D-CEUS, such as QLAB, allows a precise assessment of the shape and volume of a liver mass [9,10]. In comparison with CT measurements of liver lesions, 3D-CEUS is readily available and does not rely on the use of ionizing radiation or potentially nephrotoxic contrast agents [7,8,12]. Furthermore, US is often the preferred imaging modality for guidance of loco-regional treatments, such as RFA [13].…”

“…In this regard, three-dimensional CEUS (3D-CEUS) has been shown to improve the evaluation of tumor vascularity in comparison to conventional 2D-CEUS [4][5][6]. Computed tomography (CT) can also display the spatial structure of FLLs, but 3D-CEUS makes it possible to evaluate the response repeatedly during shortterm follow-up, without the use of ionizing radiation or potentially nephrotoxic contrast agents [7,8].…”

Diagnostic accuracy of three-dimensional contrast-enhanced ultrasound for focal liver lesions

“…Computed tomography (CT) can also display the spatial structure of FLLs, but 3D-CEUS makes it possible to evaluate the response repeatedly during shortterm follow-up, without the use of ionizing radiation or potentially nephrotoxic contrast agents. [11,12] 3D-CEUS showed rapid enhancement of tumor trophoblastic vessels at the initial stage of the artery, and presented a "dendritic" distribution feature. [12,13] The origin, course and spatial location of the trophoblastic vessels were clearly visible, which could better display the spatial location relationship between tumor trophoblastic vessels and neighboring vessels as well as the tumor body.…”

“…Computed tomography (CT) can also display the spatial structure of FLLs, but 3D-CEUS makes it possible to evaluate the response repeatedly during shortterm follow-up, without the use of ionizing radiation or potentially nephrotoxic contrast agents. [ 11 , 12 ]…”

“…3D-CEUS showed rapid enhancement of tumor trophoblastic vessels at the initial stage of the artery, and presented a “dendritic” distribution feature. [ 12 , 13 ] The origin, course and spatial location of the trophoblastic vessels were clearly visible, which could better display the spatial location relationship between tumor trophoblastic vessels and neighboring vessels as well as the tumor body. [ 7 , 14 , 15 ] 3D-CEUS can obtain the perfusion information of the entire tumor microvessels within a relatively short period of time, and the information obtained by it is relatively complete.…”